in vitro coverage loosens: three years of infertility, not five

The text as introduced · 314 words

89R513 SCL-D

By: Johnson
S.B. No. 833

A BILL TO BE ENTITLED

AN ACT

relating to conditions applicable to health benefit plan coverage

of in vitro fertilization procedures.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 1366.005, Insurance Code, is amended to

read as follows:

Sec. 1366.005. CONDITIONS APPLICABLE TO COVERAGE. The

coverage offered under Section 1366.003 is required only if:

(1) the patient for the in vitro fertilization

procedure is an individual covered under the group health benefit

plan;

(2) [ the fertilization or attempted fertilization of

the patient's oocytes is made only with the sperm of the patient's

spouse;

[ (3) ] the patient or [ and ] the patient's spouse has

[ have ] a history of infertility of at least three [ five ] continuous

years' duration or the infertility is associated with:

(A) endometriosis;

(B) exposure in utero to diethylstilbestrol

(DES);

(C) blockage of or surgical removal of one or

both fallopian tubes; or

(D) oligospermia;

(3) [ (4) ] the patient has been unable to attain a

successful pregnancy through any less costly applicable

infertility treatments for which coverage is available under the

group health benefit plan; and

(4) [ (5) ] the in vitro fertilization procedures are

performed at a medical facility that conforms to the minimal

standards for programs of in vitro fertilization adopted by the

American Society for Reproductive Medicine.

SECTION 2. Section 1366.005, Insurance Code, as amended by

this Act, applies only to a health benefit plan delivered, issued

for delivery, or renewed on or after January 1, 2026. A health

benefit plan delivered, issued for delivery, or renewed before

January 1, 2026, is governed by the law as it existed immediately

before the effective date of this Act, and that law is continued in

effect for that purpose.

SECTION 3. This Act takes effect September 1, 2025.